Provider Demographics
NPI:1629346044
Name:LURIE CHILDREN'S HOSPITAL
Entity Type:Organization
Organization Name:LURIE CHILDREN'S HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:LINA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:312-227-0352
Mailing Address - Street 1:225 E CHICAGO AVE
Mailing Address - Street 2:BOX 10
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2605
Mailing Address - Country:US
Mailing Address - Phone:312-227-0352
Mailing Address - Fax:312-227-9772
Practice Address - Street 1:225 E CHICAGO AVE
Practice Address - Street 2:BOX 10
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2605
Practice Address - Country:US
Practice Address - Phone:312-227-0352
Practice Address - Fax:312-227-9772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-13
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.014775251B00000X, 251S00000X, 273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health